Neurological, Structural, and Pandemic Emergencies: Elective Cochlear Implant Surgery during the COVID-19 Pandemic

This article is part of the following series:

While conducting research in India during the summer of 2019 for my book on cochlear implantation, I kept on coming across an interesting object: a small cardboard office supply holder shaped like a yellow and black ambulance on which it is written on the side, top, and back in block capital letters: “HEARING LOSS IS AN EMERGENCY” and “ACT NOW” I saw this office supply holder/ambulance in quite a few surgeons’ offices and Auditory Verbal Therapy (AVT) clinics. 

Image: A white, yellow, and black ambulance made out of cardboard featuring Cochlear’s logo with the words ACT NOW written on a side door in block letters. Image by author.
Image: Top view of the ambulance. On the roof is written: “HEARING LOSS IS AN EMERGENCY.” Image by author. 

In most cases, when I asked the professionals in whose office I was what they thought about the ambulance and its message, they replied that they agreed with the message although the cardboard office supply holder, while cute, was of not very good quality. This ambulance was created as a marketing strategy designed to emphasize the importance of cochlear implantation for young children—sooner rather than later and as early as possible—by the Australia-based cochlear implant manufacturer Cochlear. And I heard from therapists who attended a Cochlear-sponsored training that the training hall was decorated as if the entrance was an ambulance.

Surgeons and AVT therapists often told me that there was a race against time once an infant or child is found to be deaf as there is a critical period in which a child is maximally able to learn listening and spoken language. They stressed that this critical period is between the ages of 0 and 3 and after this, the potential of a child to become a listening and speaking person declines. In addition, they asserted that deaf children are born behind as they should have been listening in the womb. While sitting in presentation halls at the Cochlear Implant Group of India’s annual conference in October 2019, I heard presentation after presentation about this critical period and the need to act quickly. Acting quickly meant cochlear implant surgery followed by AVT and intensive listening and spoken language therapy in which the child is surrounded by talking.

Fast-forward to March 2020 when we are in the midst of a global pandemic and all so-called “elective” surgeries have been canceled and postponed. In a March 26, 2020 article in the Brisbane Times titled “Kids with hearing loss will suffer from surgery delays: Cochlear,” Cochlear’s CEO is quoted as saying: 

“A child born with hearing loss is a neurological emergency. A child born with hearing loss isn’t getting the parts of their brain that are there for hearing stimulated with sound. The quicker that gets stimulated with sound the quicker that part of the brain learns what sound is, learns what speech is and to wire itself for speech and hearing.”

“Earlier cochlear implantation for children born with hearing loss leads to them obtaining age-appropriate speech and language faster than delayed implantation.”

The article states that since “elective surgeries” have ceased, children are not being implanted– although cochlear implant surgeries have recently resumed in China and the company remains optimistic that surgeries might soon resume, as after all, the implication is that the longer one waits to implant, the less potential a child has to become listening and speaking. And Cochlear’s CEO sees deafness and hearing loss as not just an unmarked emergency but a neurological one, a commonplace assertation in cochlear implant and AVT circles. 

I am concerned about this representation of deafness as a neurological emergency and the urgency attached to it: “ACT NOW.” At this time, the COVID-19 emergency has taken precedence and families cannot act now, or at least they cannot act in the ways that they are supposed to act, and they are not given options for other ways to act. As Laura Mauldin (2016) points out in her analysis of New York-based families’ trajectories to having their children implanted, families are almost seamlessly tracked into cochlear implantation by health care providers and allied health professionals such as audiologists and speech and language pathologists. But what happens when a pandemic, an emergency like COVID-19 throws a wrench in these trajectories? What other trajectories are possible and how does the discourse that “deafness is a neurological emergency” disallow other possibilities?

I am reminded of a conversation that I had with an Indian cochlear implant surgeon. In addition to being a neighborhood ENT practitioner and ear surgeon, Dr. Swarnad had started early intervention and elementary school classes for implanted children. I had asked Dr. Swarnad about how teaching happens in his programs and he told me that teachers only used listening and spoken language and that children were not allowed to lipread. A few minutes later, he told me that what he had just said was not true and that in his school, teachers and children use all kinds of methods, they use “whatever works,” including lipreading, gesture, and some sign language (although based on what I saw in classrooms, teachers were not using Indian Sign Language). I then brought up the Cochlear ambulances and asked Dr. Swarnad what he thought about them. He replied that he did not think that deafness was an emergency per se but that because of structural barriers in educational and employment institutions, a young deaf child—who does not feel deficient or lacking now—will come to feel that she is missing something when she is old enough to enter school and perceive how others see her. He also said that schools are not designed for children who cannot participate in the typical way, through listening and speaking. I appreciated Dr. Swarnad’s recognition of these structural issues and I wondered if framing these issues as an emergency would also be productive. Instead of a neurological emergency, it seems to me that there is an (infra)structural emergency around access to education, employment, and everyday life that exceeds the boundaries of an individual deaf child and her neurology. 

Ultimately, I am concerned that families are not being offered other options besides cochlear implantation. Indian Surgeons, allied health professionals, audiologists, and speech and language pathologists typically do not tell families about Indian Sign Language and while they counsel about auditory deprivation and the rewiring of children’s brains (using the language of emergency to talk about seemingly hostile takeovers of the auditory cortex by vision), they do not talk about language deprivation (Hall et al, 2019), or the labor that families and children have to do to transduce signals, or the structural stakes of maintaining cochlear implants. Families as a result are left with fewer opportunities—and we see this especially now, with cochlear implant infrastructure ground to a halt, with no surgeries happening and with less opportunities to attend therapy sessions and receive therapy (although many therapists do teletherapy and internet-based therapy, which can reach families with access to reliable large bandwidth internet, although often with less than optimal results). As mentioned in the Brisbane Timesarticle, cochlear implants are considered elective surgery—but this does not square with the emergency framing, and the lack of other trajectories, that families are given. 

I remember talking with a mother a few years ago, this time in the United States and long before COVID-19 was a household concept, about this discourse of deafness as a neurological emergency. This mother told me that since her daughter had not been implanted until after she was three years of age, she felt guilty, since she was well aware that “she had missed the critical period.” But what happens in this critical period of COVID-19 and how might we use this as an opportunity to consider other kinds of (infra)structural emergencies that are backgrounded?

Acknowledgements: I thank Stephanie Lloyd for important comments and feedback on this post. 

Works Cited

Hall, Matthew. L., Hall, Wyatte. C., and Caselli, Naomi. K. 2019. Deaf children need language, not (just) speech. First Language39(4): 367–395.

Mauldin, Laura. 2016. Made to Hear: Cochlear Implants and Raising Deaf Children. Minneapolis: University of Minnesota Press.

Michele Friedner is an Assistant Professor in the Department of Comparative Human Development at the University of Chicago.